922 Hemospray Experience in Indonesia: The Application of Hemospray During Emergency Endoscopy: Single Tertiary Center Hospital

Abstract

INTRODUCTION: Gastrointestinal bleeding (GIB) is one of the main indication to perform endoscopy, GIB can also be potentially life threatening. In some cases Emergency Endoscopy (EE) is necessary, to identify the source and to stop the bleeding. Recently, hemostatic spray powder was introduced and one of the example is Hemospray (Cook Medical, Winston-Salem, NC, USA) that shows promising results as rapid hemostasis in primary treatment and salvage when bleeding persists after conventional methods. METHODS: The samples were taken in retrospective manner for the duration of three years since Hemospray first introduced in Indonesia from January 2016 – January 2019. This paper has obtained ethical clearance from hospital ethic committee. RESULTS: For both upper and lower GI endoscopy, we conducted a total of 2,990 procedures among which 37 procedures for 37 patients, consisted of 21 (56.8%) males and 16 (43.2%) females with average age of 67.8 years old, were EE using Hemospray. It was used in 30 (81.1%) for upper GI and 7 (18.9%) for lower GI. Hemospray was used as monotherapy for 24 (64.9%) and 13 (35.1%) as secondary modality, in which the primary treatment was argon plasma coagulation (APC) 8 (21.6%), adrenaline 4 (10.8%), histoacryl 1 (2.7%). In all cases Hemospray achieved hemostasis, with no event of rebleeding occur. Mortality rate is 37.8% (n = 14), with most deaths occur within 30 (42.9%) days after EE was done. However, none of the deaths was related to endoscopy or GIB. CONCLUSION: In all cases, Hemospray was able to achieve hemostasis and furthermore there was no event of rebleeding. When conventional modalities alone were inadequate, the combination with Hemospray appeared to be able to control the bleeding. The use of Hemospray in endoscopy is a novel technique in the management of GIB, especially the difficult cases. The advantage of Hemospray is the simplicity of the technique, thus require lower endoscopic skills compared to coagulation, injection, and clipping, the powder spray also allows easier access where source of bleeding is technically hard to access. Studies covering the efficacy, safety, combination with other techniques are still expanding with promising results, although a larger number of subject study is necessary.